TWO ESSENTIAL CLINICAL SKILL-SETS FOR COUNSELORS: THE MENTAL STATUS EXAM AND SUICIDE ASSESSMENT

 Very quick overview of MSE and suicide assessment procedures  The emphasis is on material you can use in your courses THE PLAN

 The MSE is a method of organizing clinical observations pertaining to current mental status or mental condition.  The MSE is also a primary method for communicating about cognitive or psychiatric symptoms within medical settings  Sample MSE reports are available at johnsommersflanagan.com MSE PURPOSE

 Appearance  Behavior/psychomotor activity  Attitude toward examiner (interviewer)  Affect and mood  Speech and thought  Perceptual disturbances  Orientation and consciousness  Memory and intelligence  Reliability, judgment, and insight MSE GENERAL CATEGORIES

 Watch for movement back and forth from the technical task of conducting the MSE interview and less directive listening  Think about what symptoms you see and hear about and how you might articulate them in an MSE report  The protocol I’m using is published and also available online VIDEO CLIP – CARL

 Lack of focus on or knowledge of the categories  Single symptom generalization  Interpretation of client symptoms can become very idiosyncratic and based on our own experiences MSE COMMON PITFALLS

 It’s important for students to understand how culture can affect MSE process and MSE reports  Examples from my favorite MSE and Culture assignment follow CULTURAL ISSUES

CategoryObservation Invalid ConclusionExplanation Attitude toward examiner Uncooperative and hostile Oppositional- defiant or personality disorder Has had abusive experiences from dominant culture Affect and mood No affect linked to son’s death Inappropriately constricted affect Expression of emotion about death is unaccepted in client’s culture Reliability, judgment, and insight Lies about personal history Poor reliabilityDoes not trust White interviewer from dominant culture CULTURAL ISSUES – ASSIGNMENT: GENERATING POSSIBLE INVALID CONCLUSIONS

PART II: SUICIDE ASSESSMENT

PREPARATION I  Self-Preparation: Questions to ask yourself  What issues/ideas, etc., activate my suicide buttons?  What content is most important for me to cover?  What skills, if any, do I want to integrate into this suicide assessment presentation?  More extensive info is available online

PREPARATION II  Class Preparation: Ideally, do this the week before, by looking forward to talking about suicide and emphasize:  Suicide is a provocative topic  We need to be skilled talking about it directly  We face the issue and side with life  Please come to class ready to deal with this issue

SETTING THE TONE  Opening with a personal story about working with a suicidal client can help set the tone as:  Serious  Reflective  Personal  Professional  Open

ESSENTIAL CONTENT 1.Bust the big myth 2.Get students more comfortable with this topic and with asking about suicide 3.Introduce core knowledge (suicide assessment interview components and a good reading assignment) 4.Practice a few skills (make it real) 5.Emphasize professional and ethical standards 6.Introduce suicide intervention 7.Outline decision-making components

BUSTING THE BIG MYTH (NARRATIVE )  The Big Myth or Old Narrative  Suicide ideation and gestures are signs of DEVIANCE  This is the old medical model perspective  It suggests that we, as medical authorities, assess and intervene with suicidal patients

THE NEW NARRATIVE  Suicide thoughts and gestures don’t represent deviance  Suicide thoughts and gestures represent DISTRESS  And so we have empathy WITH clients and their distress, viewing suicide ideation and behavior as a means through which they express their distress or unhappiness

NEW NARRATIVE II  The old narrative emphasized diagnostic interviewing  The new narrative implies:  Using strength-based paraphrases  Carl Rogers with a twist (O’Hanlon)  Exception and externalizing questions  Resource questions  No assumption of mental illness

VIDEO CLIP  Tommie and John  Watch for directness  Watch for Tommie’s not always positive or cooperative responses

SUICIDE INTERVIEW COMPONENTS  Suicide risk factors  Suicide ideation  Suicide plan (SLAP)  Self-control  Suicide intent

CLASSROOM ACTIVITY I  Practice asking directly about suicidal thoughts  Pair up  Say the words – don’t beat around the bush... use “suicide” or “kill yourself”  Rita S-F and the Cincinnati police

CLASSROOM ACTIVITY II  Use interview tag-team to practice interview parts  Rapport and exploring risk factors and depression  Exploring suicide ideation and plan  Evaluating suicide intent and self-control  Try out an intervention or two  Caucus together to talk about ethics, professional standards, and decision-making

 Thanks for listening and participating  Feel free to access free resources at: johnsommersflanagan.com  For detailed information on suicide assessment interview content, see: Sommers-Flanagan & Sommers-Flanagan (2012). Clinical Interviewing (4 th ed., update). Chapter 9; Hoboken, NJ: Wiley CLOSING COMMENTS